BACKGROUND: Ventricular assist device (VAD) implantation as a bridge to transplant (BTT) has become an important approach for heart transplant candidates. In this study we document our institutional long-term results and recent improvements in BTT therapy. METHODS: We retrospectively studied 531 consecutive heart transplant recipients between January 1990 and August 2007. The cohort was divided into old orthotopic heart transplant (OHT) without device (oOHT; n = 399, January 1990 to July 2003), old BTT (oBTT; n = 41, January 1990 to July 2003), new OHT without device (nOHT; n = 58, August 2003 to August 2007) and new BTT (nBTT; n = 33, August 2003 to August 2007) groups. Demographics and post-transplant outcomes were assessed. RESULTS: Post-transplant survival in the nBTT group improved significantly compared with the oBTT group (log-rank test, p = 0.01) and survival in the nOHT group tended to be higher than in the oOHT group (p = 0.19). Survival in the oBTT group was significantly worse than in the oOHT group (p < 0.01). However, there was no difference between the nBTT and nOHT groups. The mean period of BTT support was 113 (range 5 to 524) days in the oBTT group and 148 (range 38 to 503) days in the nBTT group. Multivariate analysis revealed diabetes (p < 0.01) and biventricular support (p = 0.04) as significant independent predictors of post-transplant mortality. CONCLUSIONS: Post-transplant survival has improved in recent BTT patients. Indeed, recent outcome for OHT after BTT has become equivalent to that for OHT without VAD. These data suggest that advances in device technology and our institutional multidisciplinary program have improved survival and allow BTT candidates to have an outcome equivalent to that of non-VAD patients in the recent era.
BACKGROUND: Ventricular assist device (VAD) implantation as a bridge to transplant (BTT) has become an important approach for heart transplant candidates. In this study we document our institutional long-term results and recent improvements in BTT therapy. METHODS: We retrospectively studied 531 consecutive heart transplant recipients between January 1990 and August 2007. The cohort was divided into old orthotopic heart transplant (OHT) without device (oOHT; n = 399, January 1990 to July 2003), old BTT (oBTT; n = 41, January 1990 to July 2003), new OHT without device (nOHT; n = 58, August 2003 to August 2007) and new BTT (nBTT; n = 33, August 2003 to August 2007) groups. Demographics and post-transplant outcomes were assessed. RESULTS: Post-transplant survival in the nBTT group improved significantly compared with the oBTT group (log-rank test, p = 0.01) and survival in the nOHT group tended to be higher than in the oOHT group (p = 0.19). Survival in the oBTT group was significantly worse than in the oOHT group (p < 0.01). However, there was no difference between the nBTT and nOHT groups. The mean period of BTT support was 113 (range 5 to 524) days in the oBTT group and 148 (range 38 to 503) days in the nBTT group. Multivariate analysis revealed diabetes (p < 0.01) and biventricular support (p = 0.04) as significant independent predictors of post-transplant mortality. CONCLUSIONS: Post-transplant survival has improved in recent BTTpatients. Indeed, recent outcome for OHT after BTT has become equivalent to that for OHT without VAD. These data suggest that advances in device technology and our institutional multidisciplinary program have improved survival and allow BTT candidates to have an outcome equivalent to that of non-VAD patients in the recent era.
Authors: Nir Uriel; Ulrich P Jorde; Sang Woo Pak; Jeff Jiang; Kevin Clerkin; Hiroo Takayama; Yoshifumi Naka; P Christian Schulze; Donna M Mancini Journal: J Heart Lung Transplant Date: 2013-02 Impact factor: 10.247